Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

Sanfilippo, Filippo; Via, Luigi La; Carpinteri, Giuseppe; Astuto, Marinella

doi:10.1186/s13054-022-03925-1

Cited by 3 publications

(3 citation statements)

References 5 publications

(6 reference statements)

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“…Previous studies included patients undergoing general anesthesia in an operating room [ 11 , 12 ]. In contrast, the present study included patients with CPOA who were undergoing continuous CPR; thus, their necks may have been hyperextended, and passive neck movements during CPR might be involved in RPW mucosal injury [ 19 ]. Moreover, we noticed sharp corners that were created when we pushed an NGT down; this impacted in the middle or lower esophagus, shown through the VLS image.…”

Section: Discussionmentioning

confidence: 99%

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

Miyamoto,

Takayasu,

Katsuki

et al. 2024

JCM

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Background: Patients under cardiopulmonary resuscitation (CPR) are at high risk of aspirating gastric contents. Nasogastric tube insertion (NGTI) after tracheal intubation is usually performed blindly. This sometimes causes laryngopharyngeal mucosal injury (LPMI), leading to severe bleeding. This study clarified the incidence of LPMI due to blind NGTI during CPR. Methods: We retrospectively analyzed 84 patients presenting with cardiopulmonary arrest on arrival, categorized them into a Smooth group (Smooth; blind NGTI was possible within 2 min), and Difficult group (blind NGTI was not possible), and consequently performed video laryngoscope-assisted NGTI. The laryngopharyngeal mucosal condition was recorded using video laryngoscope. Success rates and insertion time for the Smooth group were calculated. Insertion number and LPMI scores were compared between the groups. Each regression line of outcome measurements was obtained using simple regression analysis. We also analyzed the causes of the Difficult group, using recorded video laryngoscope-assisted videos. Results: The success rate was 78.6% (66/84). NGTI time was 48.8 ± 4.0 s in the Smooth group. Insertion number and injury scores in the Smooth group were significantly lower than those in the Difficult group. The severity of LPMI increased with NGT insertion time and insertion number. Conclusions: Whenever blind NGTI is difficult, switching to other methods is essential to prevent unnecessary persistence.

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Section: Discussionmentioning

confidence: 99%

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

Miyamoto,

Takayasu,

Katsuki

et al. 2024

JCM

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“…Our collected data and analysis did not allow us to conclude on criteria or timing for intubation decision and its association to invasive MV and prognosis. Because of clinical heterogeneity in daily practice and emphasized by the use of noninvasive respiratory supports (HFNO and NIV), this crucial point is still a matter of debate in the literature [44][45][46][47]. Regarding W2 and W3, our local policy for intubation has been different as we probably tolerated more severe hypoxemia and the limit for refractory hypoxemia criteria has been postponed.…”

Section: Discussionmentioning

confidence: 99%

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

Ferré,

Lamamri,

Delord

et al. 2023

Respiration

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Background: This study was carried out to compare characteristics and outcomes in patients with acute respiratory failure related to COVID-19 during first, second, and third waves. Methods: We included consecutive adults admitted to the intensive care unit between March 2020 and July 2021. We compared three groups defined by the epidemic intake phase: waves 1 (W1), 2 (W2), and 3 (W3). Results: We included 289 patients. Two hundred and eight (72%) patients were men with a median age of 63 years (IQR: 54–72), of whom 68 (23.6%) died in hospital. High-flow nasal oxygen (HFNO) was inversely associated with the need for invasive mechanical ventilation (MV) in multivariate analysis (p = 0.003) but not dexamethasone (p = 0.25). The day-90 mortality rate did not vary from W1 (27.4%) to W2 (23.9%) and W3 (22%), p = 0.67. By multivariate analysis, older age (odds ratio [OR]: 0.94/year, p < 0.001), immunodeficiency (OR: 0.33, p = 0.04), acute kidney injury (OR: 0.26, p < 0.001), and invasive MV (OR: 0.13, p < 0.001) were inversely associated with higher day-90 survival as opposed to the use of intermediate heparin thromboprophylaxis dose (OR: 3.21, p = 0.006). HFNO use and dexamethasone were not associated with higher day-90 survival (p = 0.24 and p = 0.56, respectively). Conclusions: In patients with acute respiratory failure due to COVID-19, survival did not change between first, second, and third waves while the use of invasive MV decreased. HFNO or intravenous steroids were not associated with better outcomes, whereas the use of intermediate dose of heparin for thromboprophylaxis was associated with higher day-90 survival. Larger multicentric studies are needed to confirm our findings.

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“…Indeed, when ICU beds are not a limiting factor, clinicians will evaluate the appropriateness and the correct timing of intubation without including in their evaluation the need for (possibly long) inter-hospital transfer. Under hazardous conditions performing long transfers of mechanically ventilated patients (on high fraction of inspired oxygen, and possibly on significant haemodynamic support) is not without additional risks [14] . Lack of ICU beds may delay intubation in the hope an ICU bed becomes available, or simply because the first available ICU bed is far away.…”

mentioning

confidence: 99%

The COVID-19 pandemic: a gateway between one world and the next!

Sanfilippo

Gopalan²,

Hasanin³

2022

Anaesthesia Critical Care & Pain Medicine

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Timing of intubation, beds in intensive care and inter-hospital transfer: rings of a complex chain during pandemic conditions

Cited by 3 publications

References 5 publications

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

Unchanged Characteristics and Survival among Critically Ill COVID-19 Patients during First, Second, and Third Waves: A Prospective Observational Cohort

The COVID-19 pandemic: a gateway between one world and the next!

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